Kristy L Rialon1, Brian R Englum1, Brian C Gulack1, Carlos J Guevara2, Syamal D Bhattacharya3, Mark L Shapiro4, Henry E Rice5, John E Scarborough4, Obinna O Adibe6. 1. Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA. 2. Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA. 3. Division of Pediatric Surgery, Department of Surgery, Vanderbilt Children's Hospital, Nashville, TN, USA. 4. Division of Trauma and Critical Care, Department of Surgery, Duke University Medical Center, Durham, NC, USA. 5. Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, HAFS Building, Room 6680, Durham, NC 27710, USA. 6. Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, HAFS Building, Room 6680, Durham, NC 27710, USA. Electronic address: obinna.adibe@dm.duke.edu.
Abstract
BACKGROUND: Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE. METHODS: The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting. RESULTS: Of 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31) CONCLUSION: Patients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy.
BACKGROUND: Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE. METHODS: The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting. RESULTS: Of 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31) CONCLUSION:Patients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy.
Authors: Ravi R Rajani; Jeffrey A Claridge; Charles J Yowler; Pamela Patrick; Amanda Wiant; Jessica I Summers; Amy A McDonald; John J Como; Mark A Malangoni Journal: Surgery Date: 2006-10 Impact factor: 3.982
Authors: Daniel Dent; Grady Alsabrook; Brian A Erickson; John Myers; Michael Wholey; Ronald Stewart; Harlan Root; Hector Ferral; Darren Postoak; Dacia Napier; Basil A Pruitt Journal: J Trauma Date: 2004-05